• Ozzie Paez

Saving lives in future emergencies

I authored this story several years ago based on 20+ years evaluating innovative health technologies, with input from health tech leaders and medical professionals. It describes a future that is now technically attainable in light of new generations of remote physiological monitors like those introduced by BioBeat. Streams of sensor data analyzed by advanced analytics and artificial intelligence unavailable five years ago are poised to increase survival rates and patient outcomes. These technologies are already revolutionizing emergency response, treatment, and patient support among care providers in the US, Europe, and Middle East.


Future Emergencies: A Story


George traveled almost two days from Denver to join his granddaughter, Gail, in Denbigh, Wales, United Kingdom. She was working at an archeological dig as part of her graduate studies at Oxford. He was looking forward to learning more about her work while enjoying new adventures in her company. The flight to London went well, despite his feeling more tired than usual; must be the stress and excitement, he thought. George felt reassured by the physiological health monitor he wore on his wrist. The smart medical device captured and analyzed over a dozen vital measures including respiration, blood oxygen saturation, ECG, heart rate, blood pressure, movement, and body temperature.

George's physiological monitoring was adjusted before his trip by his cardiologist, Dr. Judy Powell, to account for pre-existing heart conditions. The device's sampling frequency, real-time analysis, health notifications, and alarms were tuned to closely monitor his health. He felt confident knowing that his doctor and health support team were available during his international travels.

The adventure unfolds

George set off from London's Heathrow Airport on a rented Tesla for the 230-mile journey to Denbigh via the M41. He took rest breaks along the way to relax, enjoy local cuisines and explore nearby attractions. Eight hours later, near Denbigh, his health monitor detects an unexpected drop in blood pressure, unstable heart and respiration rates, and low activity. The device and cloud based analytical engines quickly trigger alarm sounds and vibrations to attract his attention and elicit a response. His car also received a warning message to slow down, but it was too late.


Gorge losses consciousness and swerves across the road onto an oncoming vehicle with four passengers aboard; it’s 7:45:27 PM, local time. The impact, registered by accelerometers in both vehicles and wearable monitors, triggers notifications to local emergency services (7:45:52). Two ambulances and law enforcement officers are quickly dispatched to the site tagged by GPS locators (7:48:05). Their estimated arrival time of 7:52:30 is less than five minutes after the incident.

George’s monitoring system responds by changing his status from Normal to Critical. Streams of enhanced physiological data flow from his wrist monitor to cloud servers, where powerful analytics and AI algorithms analyzed them in real-time (7:46: 05). In the other car, a 28-year-old mother and her children (5 and 7) are also wearing monitors; the father (31) had left his behind. Their monitors start transmitting and analyzing their physiological data. The mother and younger child are noted as stable, but the older brother is demonstrating signs of distress and anxiety. The father’s presence is captured by car sensors, but no real-time physiological data is available (7:50:17).

The accident victims' physiological data and analysis are simultaneously transmitted to assigned paramedics and the emergency room at a nearby hospital (7:51:00). As the EMTs rush to the scene (7:51:20), emergency room staff start evaluating the victims’ condition. The ambulances arrived on scene at 7:50:23 and paramedics began evaluating the victims’ injuries. They quickly connect the unmonitored man to their mobile emergency monitoring systems and began transmitting his physiological data to the emergency room (7:55:25). All victims, including George who is experiencing cardiovascular difficulties are quickly stabilized and transported to the hospital (8:09:38).

Meanwhile, it's almost three in the morning in Denver, when George’s monitoring system alerts Dr. Powell that one of her patients is experiencing a health emergency. She quickly logs onto her medical services portal and learns that George had an cardiac episode and was involved in a car accident in Britain. She examines the data and information, noting that the cardiac event preceded the crash.


Dr. Powel calls the assigned hospital’s emergency room at the number displayed on her screen and is connected to her British colleagues. She offers additional insights into George’s health, cardiac history, conditions, and prescriptions, including negative reactions to various medications; it's 8:05.37PM Denbigh/3:05:37AM Mountain Standard Time - twenty minutes and ten seconds after the crash.

By the time the ambulances arrive at the hospital (8:10:00AM), emergency room teams have evaluated a wealth of monitoring information and are ready to intervene. They also have electronic medical records for all the patients, including George, the tourist from Colorado. A supporting team consisting of a cardiologist, orthopedic surgeon and pediatrician arrive on site at 8:22:47 and are quickly briefed. They will be on standby and ready to support the emergency team as necessary.

BioBeat's innovative wireless patient monitoring technologies allow EMTs, Emergency Room, and hospital medical staffs to collaborate from incident and transportation, through treatment and discharge.


Welcome to the future of remote advanced patient monitoring and their role in emergency response, treatment, and recovery. Technically, the future is here, but much work remains to upgrade systems and protocols, train emergency response and hospital staffs, and fine tune operations. Business operational models will have to be updated to translate technological capabilities into innovative, financially sustainable life-saving services. Thankfully, cutting edge solutions like BioBeat's remote patient monitoring have been engineered to facilitate the transition from less capable and more costly legacy technologies.

Implications

The technical capabilities in the story are already available. BioBeat's innovative advanced patient monitoring systems are at the leading edge of new solutions. Their sixteen vital signs measurements, including cuffless blood pressure, are already deployed at hospitals and medical service provider offices in the US, Europe, and the Middle East. These technologies are saving lives by extending the "Golder Hour" of emergency response beyond hospital brick and mortar to incident sites and during transport to emergency rooms.

Dr. R. Adams Cowley is considered a pioneer in the treatment of shock trauma. He coined the term "Golden Hour" to stress the importance of getting trauma victims to emergency care without delay.

In the 1960s, Dr. Adams Cowley of Baltimore’s University of Maryland Medical Center introduced the concept of the “Golden Hour” in cases of trauma. His experiences in post-World War II Europe and Baltimore demonstrated that patient survival and recovery improved significantly when treatment was quickly administered.[1] His ideas were validated by his US Army funded study of patient outcomes following trauma-induced shock. Dr. Crowley's work changed emergency response standards based on the Golden Hour principle he introduced more than sixty years ago.

Charlie Eisele, an editorial board member of the Journal of Emergency Medical Services, flight operations supervisor and flight paramedic for the Maryland State Police highlighted the influence of Dr. Crowley's work on modern emergency medical services. The job, he stated, is generally defined by three phases: “1) get to the patient quickly, 2) fix what we can fix and 3) quickly get the patient to the right hospital. Anything we can do to compress each of these time periods is good for the patient. We’ve known this in the traumatically injured, and now we use it for STEMI (heart attacks) and stroke patients; more are sure to follow.”[2] Technologies like BioBeat's advanced patient monitoring allow ER staff to closely monitor patients before arrival and help EMT's deliver more advanced support.


Structural barriers

There are barriers to fully exploiting advanced patient monitoring technologies in emergency medical care situations. Many are due to obsolete regulations and protocols. Privacy and security concerns will have to be addressed by legislators and regulatory agencies to facilitate collaboration across international borders. As has often been the case in other industries, advanced monitoring technologies are challenging established players and practices. Fortunately, BioBeat's solutions offer compelling value propositions for most players in the heath and healthcare services delivery chains.

References

[1] Tribute to R Adams Cowley, MD, University of Maryland Medical Center, accessed July 17, 2017, http://www.umm.edu/programs/shock-trauma/about/history

[2] Charlie Eisele, The Golden Hour, August 31, 2008, Journal of Emergency Medical Services, http://www.jems.com/articles/2008/08/golden-hour.html


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